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Contribution of weekly ward rounds led by pediatric infectious diseases specialists in a pediatric intensive care
Marion de Gregorio1,2, Guillaume Mortamet3, Mina Smiljkovic2
1Pediatric Intensive Care Unit, Univ.Grenoble Alpes, Grenoble-Alpes University Hospital, La Tronche, France.
Insights
Infectious disease team recommendations in Pediatric Intensive Care Units (PICUs) showed high compliance. This highlights the effectiveness of structured infectious disease consultations for optimizing pediatric patient care.
Area of Science:
- Pediatric Intensive Care Unit (PICU) infectious diseases
- Antimicrobial stewardship programs
Background:
- Community or healthcare-associated infections are prevalent in PICUs.
- Antibiotic stewardship programs aim to optimize antimicrobial prescribing.
- Prospective audits by pediatric infectious disease teams in PICUs are linked to good adherence.
Purpose of the Study:
- To describe clinical recommendations from a weekly infectious disease team round in a PICU.
- To assess compliance with these recommendations.
Main Methods:
- Observational prospective single-center study over one year.
- Collected all clinical recommendations from infectious disease team rounds.
- Analyzed 234 recommendations for 148 pediatric patients.
Main Results:
- Recommendations covered diagnosis (42%), therapy (88%), prevention (18%), and monitoring (15%).
- Therapeutic modifications included discontinuation (35%), spectrum change (23%), and dosage adjustment (7%).
- Treatment duration was optimized in 62% of cases, with 90% overall compliance.
Conclusions:
- High compliance (90%) was observed for weekly infectious disease team recommendations in a PICU.
- Further pediatric studies are needed to confirm the impact on patient outcomes.
Abstract:
Community or healthcare-associated infectious diseases are common in Pediatric Intensive Care Units (PICUs). The main objectives of this study were 1/to describe the clinical recommendations given during weekly round of infectious disease team into a PICU and 2/to assess its compliance.An observational prospective single-center study conducted over a one-year period in a PICU of a tertiary university hospital. All clinical recommendations provided by an infectious disease team during a weekly round were collected. We reported a total of 234 clinical recommendations on 148 patients (median age 34 months [IQR 2,5 months -126 months], 52% males). Infections occurred in patients with comorbidity in 73 (49%) of them. Ninety-three patients (40%) had pulmonary infections and patients presented with septic shock in 27 cases (12%). Clinical recommendations were categorized as diagnosis, therapeutic, preventive and monitoring in 98 (42%), 205 (88%), 41 (18%), 34 (15%) respectively. There were many therapeutic modifications after round, including treatment discontinuation (n = 82, 35%), spectrum modification (n = 54, 23%) and dosage adjustment (n = 15, 7%). The duration of treatment was also optimized in 144 situations (62%). Overall, we found a complete compliance with recommendations in most cases (n = 212, 90%).
Conclusion:
We found a very good compliance of clinical recommendations provided on a weekly basis by an infectious disease team in a PICU. Larger pediatric studies are warranted to assess a potential benefit on patients' outcome.
What Is Known:
• Antibiotic stewardship programs have been developed to optimize antimicrobial prescribing practices.
What Is New:
• A prospective audit and feedback from a pediatric infectious disease team during once weekly rounds in PICU is associated with good adherence. • Recommendations did not focus only on therapeutic management but also on diagnosis, prevention and follow-up.
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